Are Dutch general practitioners willing to prescribe mifepristone and misoprostol?

Abstract

The World Health Organization (WHO) indicates that General Practitioners (GPs) can effectively and safely provide mifepristone and misoprostol for medical termination of pregnancy (TOP). Dutch GPs are permitted to treat miscarriages with mifepristone and misoprostol, but in practice only guide spontaneous miscarriages. Current Dutch abortion law forbids GPs to prescribe these medications for medical TOP. Medical TOP is limited to the specialized settings of abortion clinics and hospitals. A shift to primary care is debated in the House of Representative, following the example of France and Ireland. It would improve reproductive health care and choices for women. Little is known about GPs’ willingness to provide medical TOP and miscarriage management. This study aimed to gain insight into Dutch GPs’ willingness and anticipated obstacles to prescribing mifepristone and misoprostol for medical TOP and miscarriages. This is a mixed-method study among Dutch GPs. A questionnaire provided quantitative data that was analysed using descriptive methods. Thematic analyses were performed on qualitative data collected by in-depth interviews. The questionnaire was sent to 575 GPs, the response rate was 22.1%. Of the responders, 84.3% were willing to prescribe mifepristone and misoprostol and 58.3% were willing to provide both medical TOP and miscarriage management. 57.5% indicated a need for training. The main barriers influencing GPs’ willingness were lack of experience, knowledge, time and a restrictive abortion law. Over 80% of the respondents were willing to prescribe mifepristone and misoprostol for medical TOP or miscarriages. Training, (online) education and a revision of the abortion law are recommended.